Provider Demographics
NPI:1376550186
Name:STEVENS, ALEXANDRA D (LMP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 NE HIGHWAY 99 STE D
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8859
Mailing Address - Country:US
Mailing Address - Phone:360-551-8511
Mailing Address - Fax:
Practice Address - Street 1:12306 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6061
Practice Address - Country:US
Practice Address - Phone:360-551-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA155580225700000X
WAMA00015580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601289760Medicare UPIN